[e-drug] Access to essential medicines as a human right (2)

["Peter Mansfield" <peter.mansfield@adelaide.edu.au>]

E-DRUG: Access to essential medicines as a human right (2)
----------------------------------------------------------

Hans,

Litigation can also be used by drug companies to force governments to pay
for non-essential drugs that are expensive and thus not cost effective. This
can divert resources and thus reduce access to essential drugs. Part of the
problem is that courts, like many health professionals, tend to focus on
individual cases rather than the community as a whole.

For example Joana Ramos ( Social Worker, Health Policy; Cancer Resources &
Advocacy, Seattle, USA http://ramoslink.info/ ) has told me that ?because
Brazilian citizens have the constitutional right to health care, there have
been increasing numbers of civil suits brought by patients to require their
municipal health units provide them with medicines that are not available,
or not readily available under the Brazilian national health service
(Sistema Único de Saúde, or SUS). Due to the law, the courts are almost
always obliged to order the municipal health units to provide these new
drugs. These drugs are usually imported and very expensive. Many of the
initial requests came from patients with AIDS and cancer.? 

According to a report published by the Brazilian National Council of
Municipal Secretaries of Health in May 2005:
 
?It is a fact that the Law guarantees the right of people? and
administrators do not deny that they are right in seeking their rights in
the Court. But they complain that, precisely because of its coverage, the
Law does not anticipate a series of other situation. For instance: the
provision of medications that are not registered with the Health Ministry
yet or that are not on the list of SUS?s medications, the lawsuits for
treatment and surgery overseas; legal demands for patients who are not users
of the public network, and abuses of all kinds against the system. The flood
of legal actions caused by gaps in the legislation ends up causing the
non-compliance with preliminaries. Whatever the case, the patient is always
the one most harmed.

?The situation here has got to such a point that, there are preliminaries
for [legal action about] the provision of special milk, geriatric diapers
and even Viagra?, reveals the municipal secretary of health in Goiânia,
Otaliba Libânio. ?To satisfy these preliminaries, we have to create
re-management mechanisms for resources, even being subject to interrogation
from the Accountancy Tribunal later on?, he argues. ?That is without
mentioning the number of patients who are left without Basic Care assistance
who go without being attended to satisfactorily due to a lack of resources.?
The most serious problems, however, are the demands for high cost
medications or ones that do not figure in clinical protocols from the Health
Ministry. A great many legal actions against SUS demand medications that are
in trial phases, which are not registered in the Ministry and that cost a
great deal more that conventional medicines. Administrators attribute a
great deal of blame on marketing from the pharmaceutical industry and the
lack of conscience from doctors who prescribe these treatments.

?The truth is that large laboratories perceive the gap in the legislation,
an attraction for sales, from which we cannot escape. After all, legal
demands have to be satisfied?, says Libânio. ?There are doctors who
prescribe the most expensive medications and together with the prescription
they even provide a business card of some law firm so that the patient can
get the medications in the Court?, he reveals. The Federal Council of
Medicine has already been approached, but it did not want to make a
statement on this question. The press advisory from the Council in Brasília
explained that the issue had not been debated in plenary and that there was
no consensus from the category.

For the consultant, at the Health Ministry, Paulo Picon, pressure from large
laboratories is the sole responsible factor for such high demand for
medications not on SUS?s clinical protocols. The specialist, who is also a
technical coordinator for the medication policy in Rio Grande do Sul,
reveals that, of the 450 lawsuits that are in progress against the State,
70% request medicines that are not part of SUS?s list. Many of them,
medicines recently launched by large laboratories, are still in the testing
phase.

?It is secular marketing, aggressive and almost perfect. The laboratories
give handouts to physicians, sponsor trips, finance congresses and even
provide juridical assistance to patients?, lists in detail Picon. This
pressure, according to him, generates a vicious and difficult to break
circle: ?The physician prescribes the medication that the laboratory wants
and the patient never questions the physician. The Public Ministry cannot
change the prescription and the Justice always decides for the right
guaranteed in the Constitution. In this way, the State has to put up with a
much higher expenditure to provide that medication and lacks resources for
basic care patients?, he says.?<1> 

1. Health as the Defendant. Brazilian National Council of Municipal
Secretaries of Health (CONASEMS) 2005 May 4
www.conasems.org.br/mostraPagina.asp?codServico=1555&codPagina=2455

regards,

Peter

Dr Peter R Mansfield
GP
Director, Healthy Skepticism Inc. Countering misleading drug promotion.
www.healthyskepticism.org
peter@healthyskepticism.org
Research Fellow, Discipline of General Practice, University of Adelaide.
www.adelaide.edu.au/directory/peter.mansfield
peter.mansfield@adelaide.edu.au